Des Moines Senior AdvisorHow many staff must an Iowa assisted living program have on duty?
Enough trained staff at all times to fully meet tenants' identified needs (481 IAC 67.9), with at least one staff person on site and in the proximate area around the clock who can respond to a call light or other urgent need (481 IAC 69.29).
Iowa sets no numeric ratio for assisted living. Every tenant must have a 24-hour personal emergency response system that identifies the tenant and works with one touch, unless the program serves people with dementia and uses written response procedures instead. Ask any program for two recent weeks of staffing schedules, broken out by shift, and compare them with the number of tenants who need two-person help or frequent checks.
What role do nurses play in Iowa assisted living?
Each program has a registered nurse who delegates tasks to trained staff, makes sure staff are competent for the tasks assigned, trains new staff within 30 days of hire, and reviews tenants receiving health-related care at least every 90 days (481 IAC 67.9 and 69.27).
A newly hired program nurse must document a review of staff training and competence within 60 days. At least one delegating nurse per program must have completed an assisted living nursing or manager class that includes six hours on Iowa's assisted living rules, and the program manager needs the same within six months of hire (481 IAC 69.29). Ask how many hours a week the nurse is physically in the building, and who covers when the nurse is on vacation.
Who gives medications in a Des Moines assisted living program?
Tenants self-administer their medications unless the tenant or legal representative delegates part of the setup or administration to the program in the occupancy agreement or signed service plan, and the program may not stop a tenant from self-administering (481 IAC 67.5).
When the program handles medications, it follows its written medication policy under nurse delegation, and a program that stores or administers controlled substances must register with the Iowa Board of Pharmacy as a care facility. Ask who sets up weekly pill organizers, whether staff give medications at set times or remind tenants, how as-needed medications are handled at night, and what the program charges for medication management, since it is usually a separate line on the bill.
What background checks does Iowa require for assisted living staff?
Criminal history and dependent adult abuse record checks before employment (481 IAC 67.18), and staff must be trained to recognize and report dependent adult abuse as Iowa Code 235B.16 requires.
Program staff may not serve as a tenant's attorney-in-fact, guardian, conservator or representative payee unless related by blood, marriage or adoption (481 IAC 67.9(5)). That rule protects tenants from conflicts of interest; if anyone at a program offers to manage a parent's money or sign as power of attorney, decline and tell the manager.
What must an Iowa service plan include?
A written plan, built before move-in for tenants needing personal or health-related care, that lists the services and care the program will provide under the occupancy agreement, who provides them and how often, and that is updated within 30 days of occupancy, at significant changes and at least yearly.
Small additions can be made after a nurse review when no significant change has occurred. The plan is the document to hold the program to: if bathing three times a week is written in, it should happen three times a week. Keep a copy, bring it to each review, and write down changes you agree on. Program staff must also record in writing any change in a tenant's usual health, function or cognition, and keep those notes for three years.
Side by side
| Iowa requires assisted living programs to | Iowa does not require assisted living programs to | |
|---|---|---|
| Night staff | Keep staff on site 24 hours a day | Keep a nurse on site overnight |
| Emergencies | Give each tenant a one-touch call system (or written procedures in dementia care) | Install the same system everywhere |
| Nursing | Have an RN delegate and review care every 90 days | Provide daily skilled nursing |
| Medications | Respect a tenant's right to self-administer | Manage every tenant's medications |
Drawn from Iowa Code chapter 231C, 481 IAC chapters 67 and 69, Iowa HHS and DIAL publications, CareScout, CMS, the VA and the aging agencies cited in the text; our editorial standards explain how we check them.
